Method of performing intestinal intubation



July 10, 1962 H. F. M CARTHY METHOD OF PERFORMING INTESTINAL INTUBATIONFiled Sept. 29, 1959 2 Sheets-Sheet l HORACE FRANK McCARTHY INVENTORATTORNEYS.

July 10, 1962 H. F. M CARTHY 3,

METHOD OF PERFORMING INTESTINAL INTUBATION Filed Sept. 29, 1959 2Sheets-Shee t 2 SUCTION /as 4O 44 2| 24 J 0 o L 1 23 POWER 1 43 g LINESI T r 0.0. POWER 36 SUPPLY A ORNEYS.

3,043,309 METHOD F PERFORMING INTESTINAL INTUBATION Horace Frm rMcCarthy, North Andover, Mass., assignor to Ave-o Corporation,Cincinnati, Ohio, a corporation of Delaware Fiied Sept. 29, 1959, Ser.No. 843,994

6 Claims. (Cl. 128-348) A V This invention relates to an intubationprocedure and more particularly an apparatus used in performingintestinal intubation.

Very frequently there Will develop in the intestines a block whichprevents food and waste products from passing from the stomach and theintestines to the outside of the body. Food and waste products build upgases as a consequence of increased bacterial activity in the digestivetract behind the block. The gases distend, or expand, the digestiveorgans greatly, giving rise to an extremely painful and dangerouscondition. While it is possible to perform surgery to remove the blockwith the patient in a distended condition, the operation is consideredto be extremely hazardous. A preferred procedure is to decompress thedigestive system by inserting a perforated tube into the digestivesystem, and applying a suction force at the exterior end of the tube toremove the trapped gases, the food and waste products causing thedistended condition. The procedure just discussed is commonly calleddecompression by means of intestinal intubation. I

- It is extremely simple to insert a flexible tube into the stomach.However, if the block is in the intestinal system the tube must be madeto pass from the stomach into theintestinal system. At the junction ofthe stomach and the entrance to the intestines, there exists a ring-likemuscle surrounding a passage defined by the junction, called thepylorus. The pylorus acts as a valve for controlling the movement offood from the stomach to the duodenal portion of the intestine.Normally, the pylorus obstructs the passage between the stomach and thein testinal tract. To pass the tube fromthe stomach to the intestinaltract, the pylorus must be made to act and open the passage.

There are several ways in which the pylorus can be made to open. In thenatural digestive process, the stomach produces an acid which causes thepylorus to open. Attempts have been made to insert liquids which arechemically identical and have the same concentration as the acid whichis produced by the stomach during a normal digestive operation. However,these efforts have not been too successful since the pylorus isapparently able 'to discriminate between a normal digestive product anda synthetic substitute.

The practice most widely used consists of inserting a tube into thepatients stomach and permitting the peristaltic and churning action ofthe stomach to bring the tip of the intubation tube in contact with thepylorus. It appears that the pylorus is sensitive to mechanical contactand responds to the contact by dilating, or opening the passage betweenthe stomach and the intestines. The basic technique just described hasbeen refined in several ways, namely: (1) weighting the tip of theintestinal tube to make use of a gravitational effect on the Weightedend for moving it into the stomach and to contact the pylorus; (2) themedical profession has also used an intubation tube which increases theperistaltic actions of the stomach by means of an inflated ballo n; and(3) water jets have also been employed for carrying the tube through thepylorus and intestinal tract. 7 V

Most of the modifications or refinements of the basic technique have notbeen generally successful and are not used extensively. The medicalprofession today relies H attests Patented July i0, 196% almostentirelyon the basic technique of permitting the normal churning actionof the stomach to carry the flexible tube to the pylorus. The degreeofsuccess incident to this procedure is dependent largely, and sometimessolely, on the continuous efforts of the attending physicians and forthe most part depends on a chance passage of the tube from the stomachto the pylorus.

A normal intubation operation, as generally practiced today is a timeconsuming operation, frequently requiring hours to days, for the tube tomake a complete passage from the stomach to the region of the blockinthe intestinal tract. Current methods are also not considered tooreliable from several other standpoints. Natural abnormalities in thestomach construction, or abnormalities induced by the distendedcondition of the patient, often makes it impossible to intube thepatient. Where a patient is having difiiculty intubing by theconventional natural process, a decision to operate may have to be madewithout waiting for decompression because of the seriousness of thepatients condition. Furthermore, since the patient is frequently X-rayedto determine whether he has been intubed, prolonged exposure tohazardous radiation may occur.

It is an object of the present invention to provide an intestinalintubation method which avoids the limitations and disadvantages ofprior intubation devices.

It is another object of this invention to provide an intestinalintubation method which greatly facilitates and greatly shortens anintubation operation. I

It is still another'object' of the invention to provide an intestinalintubation method which includes means for guiding the intubation tubeto the pylorus for stimulating the pylorus, causing it to open thepassageway between the stomach and the intestines.

It is. still another object of the invention to provide an intestinalintubation method which utilizes a magnetic means in conjunction with anintubation tube for intubing a patient.

It is another object of the invention to provide an intestinalintubation method utilizing an inexpensive, reliable and an easilyoperated apparatus for guiding the intubation tube in its passagethrough the stomach to the intestinal tract.

It is yet another object of the invention to provide an electromagneticmeans designed and constructed for use in intubing a patient.

It is yet another object of the invention to provide electromagneticmeans for an intubation apparatus which generates an optimum magneticfield intensity in a predetermined direction for attracting a magneticmeans positioned at a distance from the electromagnetic means.

Finally it is an object of the invention to provide an intubationapparatus including an electromagnetic means which includes featuresmaking it especially suitable for manual manipulation during anintubation operation.

An important aspect of this invention is to provide a method forperforming intestinal intubation which comprises securing magneticmember to the tip of an elongated, X-ray opaque, flexible tube. The tipand tube are then passed through the esophagus to the stomach of apatient. Preferably, the stomach region is then illuminated by means ofX-rays, and the tube is observed on fluoroscopic screen. A maneuverablemagnetic field is then applied to the magnetic material to directthetip, to which the magnetic material is secured, to the pylorus valve inthe stomach.

Another aspect of this invention is to provide an intubation apparatuscomprising a highly flexible intubation tube which is adapted to passthrough the intestinal tract of a patient. The intubation apparatus alsoincludes magnetic means, comprising preferably a magnet, positioned inthe tip of the intubation tube. Finally, the intubation in thedigestivetract.

' preferably a soft iron elongated rod. A concentric coil is wound aboutthe rod, and its radial build-up made large to provide substantialleakage flux,i .e., flux which does not pass through the core. Theleakage flux converges or focuses the magnetic field developed by theelectromagnetic means along the axis of thecore, when the coil isenergized by' a rated current.

The novel features that are considered characteristic of the inventionare set forth in the appended claims; the invention itself, however,both as to its organization and method of operation, together withadditional objects 7 and advantages thereof, willbest be understood fromthe following description of a specific embodiment when read 4 Volume 2,edited by Otto Glasser, Year Book Publishers, 1950, starting on page274. It will be understood that most of the other intubation tubes shownand described in the aforementioned chapter can also be used. Anintubation tube may be as long as twenty-eight feet, and includesmarkings along its length which indicate the position of the distal tip21 in the digestive tract. For

in conjunction with the accompanying drawings, in which:

FIGURE 1 is a front view of a patient showing in outline the alimentarycanal and a decompression tube inserted therein; 1

, FIGURE 2 is an enlarged view of the intubed stomach region of thepatient in FIGURE 1 showing the stomach in section;

FIGURE 3 is a representation of a tip of an intubation tube showingmagnetic means positioned therein;

FIGURE 4 is a representation of an electromagnetic means constructed inaccordance withthe principles of v the present invention; and

FIGURE is a control circuit diagram; The novel method is best describedby discussing the structural features of an apparatus used to practicethe method and the operation thereof.

, Referring to FIGURE 1 of the drawings where there is represented afront view of an intubed patient 10 showing the digestive tract in dashoutline and an intubation tube 11 positioned therein, typically, thepatient 10 is placed face up on an X-ray table 12. The intubationoperation is observed by passing X'-rays from the table through the body16 to a fluorescent screen 13 placed over the patient 10. The intubationtube 11, hereinafter called the tube, is passed through the nose 14 ofthe patient into the esophagus 16, to the stomach 17. From the stomach17 the tube 11 passes through the pylorus 18 into the intestinaltract'19. A tip 21, commonly called the distal example, a markSindicates that the tip of the tube is just entering the stomach. Asecond marking, P, is located six inches beyond S and indicates thatthere is now suflicient tube in the stomach to allow the distal tip topass through the pylorous.

A third marking D is placed six inches beyond P and from thereon thetube is calibrated in feet.

The intubation apparatus also includes a means for generating a magneticfield which is adapted to couple the magnet 23 in the tip 21 fordeveloping on the magnet a force, whereby the magnet, and the tube '11,in which it is positioned, is directed towards the pylorus 18. Normally,the force developed will tend to attract the magnet 23. However, it willbe shownthat a repulsive force may also be developed. FIGURE 2 of thedrawings shows the tube 11 passing through the stomach 17 with the'tip21in contact with the pylorus 18.

The electromagnetic means comprises preferably an electromagnet 26 whichis designed and constructed for manual manipulationand control. It isoften difiicult to pinpoint the precise location of the pylorus 18, butin all cases, it is' possible to ascertain its approximate locationand'to direct the tube 11 to its immediate vicinity. As

, seen in FIGURE .2, the magnet 26, with the aid of the X- tip, of thetube 11 is shown adjacent to an intestinal lock. The region of theintestinal tract 19 immediately in back of the intestinal block is showndistended as a result'of the pile-up of food; waste products and gasesReferring briefly to FIGURE 3 of the drawings there is frepresentedtherein the distal tip 21, in a partial sectional view. It will be notedthat there is positioned within the' tube a magnetic means 23, which maybe a piece of ''ferromagnetic material or an electromagnet, butpreferlably comprises a permanent magnet; .The tube 11 extendsintegrally from the distal tip 21 and includes numerous holes 24distributed over its surface. When a suctionforce is applied to theexternal or proximal end of /2 of, an inch long.

The most widely-used int bation tube .11 is a long tube is shown anddescribed in the chapter on decompression of'the digestivetractfoundinMedical Physics,

rays and fluoroscopic screen, is positioned opposite the approximateposition of pylorus 18 on the outside of the patient 10; As .will beseen hereinafter, the maximum magnetic field intensity willbe developedalong the axis of the core 27 to forcibly attract the magnet 23.

It is well to point out, at this time, that the peristaltic and churningaction of the stomach provide partly: the motivating force for drawingthe tube 11, into the intestinal tract and intestinalperistalsis'provides, the primary force for drawing the tube 11 throughthe intestines. The pylorus 18, when it 'is open, also exhibits aperistaltic action which draws the tube through the passageway from thestomach 17 to the intestine 19. Accordingly, the first function of theintestinal intubation apparatus is to make contact between the tube 11and the pylorus 18, to stimulate the pylorus 18, causing it to. open thepassageway a Referring to FIGURES 3 and 4 of the drawings there Levintube called the gastro-duodenal tube. The Levin are represented thereina preferred construction of the electromagnet 26. The electromagnet 26comprises a magnetic core 27 formed from a rod of magnetic material,preferably soft iron. The rod is approximately six inches long and oneand one-quarter inches in diameter. A concentric coil 29 coversapproximately five inches of rod'27 and comprises a pair of end pieces31and 32, the latter including a handle 33 extending integrally therefrom.The electrical conductors making up the coil 2? are wound in the spacebetween the end pieces 31 and 32. In order to maintain a reasonable sizeand weight,

the coil 29 comprises, in this instance, a plurality of windings 34,each of which comprises a plurality of concentric turns made upofanodized aluminum strip 35. As is well known, the aluminum surfaceformed in an anodizing process can be made nonconductive and for thevoltages normally used to energize the electromagnet 26, an anodizedsurface provides adequate insulation between the turns of the windings34. V

Current is suppliedto the windings through a pair of As seen in FIGURE 2the handle 33 and 41 are coupled. The leads '40 and 41, as will be seenhereinafter, are in the control circuit of the electromagnet 26.

The number of turns used in making up the coil 29 is a function of thespace allocated for the coil, the current available to energize the'coiland the material used in the magnetic core 28. A design which has beenfound suitable comprises five windings 34 having 140 turns per windingof 0.015 inch thick aluminum strip. The total resistance of the coil 29was found to be 0.6- ohm and a current of 40 amperes was found todevelop a magnetic field intensity of 150 gauss, at 4 inches from thecore face. Clinical tests of this design of an intestinal intubationapparatus have shown it to be satisfactory. Under normal clinicalconditions the above described electromagnet was used in intubing apatient in about ten to fifteen minutes total time. It is estimated thatthe initial separation between the magnet 23 in the intubation tube 11and the face of the core 27, on the outside of the patient, will varyfrom six to eight inches.

It is clear from FIGURE 2. that it is desirable to construct a magneticfield having a maximum intensity parallel to the axis of the core 27.Accordingly, there is provided means for converging, or focusing themagnetic flux lines along a desired direction. The focusing means makesuse of a leakage field surrounding, but not within the core 27, fordirecting the flux lines produced in the core along its axis. Theleakage field is produced in the following manner. It is well known thatthe magnitude of flux produced in a magnetic field is proportional tothe product of the number of turns in the energizing coil 29 and thecurrent flowing in the coil. Accordingly, the number of ampere turnsdeveloped in the coil 29 is of sufiicient magnitude to fully saturatethe coil 27 and to create flux lines outside of the core 27. The fluxlines which do not couple the core 27 make up a leakage field.

- It is also well known that the ability of a flux line developed in anyparticular turn of a coil to couple the magnetic core 27 is related tothe distance between the turn in question and the core. Accordingly, thecoil 29 has been constructed to have a substantial radial build-up, thusassuring that a substantial leakage field will be developed after themagnetic core 27 has been fully saturated.

The over-all magnetic field developed by the electro magnet 26 isdepicted in FIGURE 4. It will be noted that there is a higher density offlux directed along the axis of the core 27 than at distances radiallyremote from the core 28. The flux lines are more widely separatedlaterally of the core 27.

Referring to FIGURE of the drawings, there is depicted therein a currentsupply means comprising a DC. power supply 43 which generates aunidirectional current. The output terminals of the DC. power supply 43are coupled through a current reversing switch 42 to the electromagnet26 by means of conductors 36 and 37. The polarity of the electromagnet26, as is conventional, is controlled by the direction of current in itscoil 29. Its polarity further determines whether the magnet 23 will beattracted or repelled. Witch 42 is a conventional double pole doublethrow current reversing switch. Interposed between the power lines andthe input terminals of the DC. power supply 43 is the push button 39which lies in the energizing path of an electromagnetic relay 44. Theelectromagnetic relay includes a pair of contacts 45 which lie in thecurrent path of the energizing circuit of the DC. power supply 43. Thepush button 39 is shown in a normally open position. When it isdepressed, current from the power lines flows through the coil 46 of therelay 44 thus closing the contacts 45. When the contacts 45 are closedcurrent is drawn from the power lines by the DC. power supply 43 forenergizing the electromagnet 26.

While the operation of the intubation apparatus is ob- 6 vious, a briefsummary will be given. Initially the distal tip 21 of the intubationtube 11 is inserted in the nose of the patient 10 and directed by thephysician into. the stomach 17 of the patient. When the distal tip 21 isobserved, through the fluoroscope screen 13, entering the stomach 17,the electromagnet 26 is positioned against the body of the patientopposite the pylorus 18 as shown in FIGURE 2. The push button 39 isdepressed and the electromagnet 26 is energized producing a magneticfield which is generally directed along the axis of the core 27.

The magnetic field interacts with the magnetic field of the tive forcetending to-pull the distal end of the intubation tube 11 toward thepylorus.

This attractive force cooperates to bring the distal end 21 into contactwith the pylorus. As described herebefore, the pylorus 13 is stimulatedby the contact of the tube and opens the passageway between the stomach17 and the intestine 19. With the passage open, the magnetic force aidedby the peristalsis of the stomach, the pylorus, and the intestine whenthe tube 11 finally enters the intestine, moves the tube 11 through theintestine. A suction force is applied to the proximal end of the tubethat lies outside of the patient and the food, waste products and gasesfound in the digestive tract are sucked into the tube and carriedoutside of the patients body. The suction force may be applied while thepatient is being intubed since it has been found that it will have noadverse effect on the intubation procedure. 7

On occasion, the tip 21 may become wedged in the stomach wall so thatmovement toward the pylorus is prevented. An assist in freeing the tip21 can be obtained by reversing the current in the electromagnet, bymeans of switch 42, to repel the magnet 23 andconsequently tip 21.

The various features and advantages of the invention are thought to beclear from the foregoing description. Various other features andadvantages not specifically enumerated will undoubtedly occur to thoseversed in the art, as likewise will many variations and modifications ofthe preferred embodiment illustrated, all of which may be achievedwithout departing from the spirit and scope of the invention as definedby the following claims.

I claim:

1. An intestinal intubation method comprising:

(a) securing a magnetic member to the tip of an elongated flexible tube;

(b) passing the tip and the tube through the esophagus to the stomach ofa patient; and

(c) applying a maneuverable magnetic field to the magnetic material anddirecting said tip to the pylorus valve in the stomach,

2. The method as described in claim 1 in which said magnetic member is apermanent magnet.

3. An intestinal intubation method comprising:

(a) inserting a magnetic member in the tip of an elongated flexibletube, said magnetic member being dimensioned to engage the walls of saidtube to be secured thereby;

(b) passing the tip and the tube through the esophagus to the stomach ofa patient; and

(c) applying a maneuverable magnetic field to the magnetic material anddirecting said tip to the pylorus valve in the stomach.

4. An intestinal intubation method comprising:

(a) securing a magnetic material to the tip of an elongated flexibletube;

(b) passing the tip and the tube through the nose and through theesophagus to the stomach of apatient; and

(c) applying a maneuverable magnetic field to the magnetic material anddirecting said tip to the pylorus valve in the stomach.

magnetic material and directing said tip to' t he' pylorus valve inthe'stomach. I

6; An intestinal intubation method comprising:

(a) securing a magneticmember to the tip of an elongated flexible tube;

to the stomach of a patient; and

I (12) passing the tip and thetube through the esophagus 5 a '(c)applyingan' electrically reversible and maneuverable magnetic fieldto-the'magnetic material for attracting and repelling said tip fordirecting said tip to the pylorns valve in the stomach. 5

References Cited infthe file of this patent.

' UNITED STATES PATENTS 1,736,182 Wilkins Nov; 19, 1929 2,184,152 SaflirV e. 19, 1959 2,863g458 5 Modnyet a1. Dec. 9; 1958 2,897,411 Brown et a1July 28, 1959 V FOREIGN PATENTS 281,869 Germany Feb. 3, 1915

